Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden.
Diabetologia. 2014 Mar;57(3):473-9. doi: 10.1007/s00125-013-3126-3. Epub 2013 Dec 14.
AIMS/HYPOTHESIS: Several environmental contaminants, such as polychlorinated biphenyls, dioxins, bisphenol A and phthalates, have been linked to diabetes. We therefore investigated whether other kinds of contaminants, perfluoroalkyl substances (PFAS), also called perfluorinated compounds (PFCs), are also associated with diabetes.
The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study investigated 1,016 men and women aged 70 years. Seven PFAS were detected in almost all participant sera by ultra-high performance liquid chromatograph/tandem mass spectrometry. Diabetes was defined as use of hypoglycaemic agents or fasting glucose >7.0 mmol/l.
114 people had diabetes. In the linear analysis, no significant relationships were seen between the seven PFAS and prevalent diabetes. However, inclusion of the quadratic terms of the PFAS revealed a significant non-linear relationship between perfluorononanoic acid (PFNA) and diabetes, even after adjusting for multiple confounders (OR 1.96, 95% CI 1.19, 3.22, p = 0.008 for the linear term and OR 1.25, 95% CI 1.08, 1.44, p = 0.002 for the quadratic term). Perfluorooctanoic acid (PFOA) also showed such a relationship (p = 0.01). PFOA was related to the proinsulin/insulin ratio (a marker of insulin secretion), but none of the PFAS was related to the HOMA-IR (a marker of insulin resistance) following adjustment for multiple confounders.
CONCLUSIONS/INTERPRETATION: PFNA was related to prevalent diabetes in a non-monotonic fashion in this cross-sectional study, supporting the view that this perfluoroalkyl substance might influence glucose metabolism in humans at the level of exposure seen in the general elderly population.
目的/假设：多种环境污染物，如多氯联苯、二恶英、双酚 A 和邻苯二甲酸酯，与糖尿病有关。因此，我们研究了其他类型的污染物，全氟烷基物质（PFAS），也称为全氟化合物（PFCs），是否也与糖尿病有关。
乌普萨拉老年人血管前瞻性研究（PIVUS）调查了 1016 名年龄在 70 岁的男性和女性。通过超高效液相色谱/串联质谱法，在几乎所有参与者的血清中检测到七种 PFAS。糖尿病的定义为使用降血糖药物或空腹血糖>7.0mmol/l。
114 人患有糖尿病。在线性分析中，七种 PFAS 与现患糖尿病之间没有显著关系。然而，在调整了多个混杂因素后，PFAS 的二次项显示出全氟壬酸（PFNA）与糖尿病之间存在显著的非线性关系（线性项的 OR 为 1.96，95%CI 为 1.19-3.22，p=0.008；二次项的 OR 为 1.25，95%CI 为 1.08-1.44，p=0.002）。全氟辛酸（PFOA）也显示出这种关系（p=0.01）。PFOA 与胰岛素原/胰岛素比值（胰岛素分泌的标志物）相关，但在调整了多个混杂因素后，七种 PFAS 均与 HOMA-IR（胰岛素抵抗的标志物）无关。
结论/解释：在这项横断面研究中，PFNA 与现患糖尿病呈非线性关系，这支持了这种全氟烷基物质可能在一般老年人群中暴露水平上影响人类葡萄糖代谢的观点。
